Form Tabulasi-rev-fitri.xlsx

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Format Tabulasi Asuhan Gizi dan Dietetik Kode Prov DIY DIY DIY DIY DIY DIY DIY DIY

Kode Kab/Kota

Petugas Konseling

No. Reg.

Tgl Konsul

Nama

Jenis kelamin L

DPC Kulon Progo DPC Kulon Progo DPC Kulon Progo DPC Kulon Progo DPC Kulon Progo DPC Kulon Progo DPC Kulon Progo DPC Kulon Progo

Sri Renaningsih, AMG Sri Renaningsih, AMG Sri Renaningsih, AMG Sri Renaningsih, AMG Sri Renaningsih, AMG Sri Renaningsih, AMG Sri Renaningsih, AMG Sri Renaningsih, AMG

.07007389 .03003351 .08011922 .05003516 .08011766 .07004600 .04003874 .07004002

25-Jan-18 Adel R 30-Jan-18 Sri Sumarni Dian Anggraeni Ayu Cipto 31-Jan-18 Ngatirah Eky Sulistyaningtyas Nuryani Rinawati

P v v v v v v v v

Umur Thn

30 32 22 35 24 29 34

JUMLAH

Umur Kondisi khusus Bln

Diagnosis Medis Alergi

Tindak lanjut

Rekomendasi Diet

Hamil Menyusui Anak Telur Susu Kacang Gluten Udang Ikan Hazelnut Perlu Tidak

10

v v v v v v v v

v v

Biasa v

DM v

v

v

TETP v v

v v

Khusus

v v TETP TETP

Assesmen Gizi Antro Anak BB (kg) TB (cm) LILA (cm) 6.6 73 67.3 46.3 56.6 58.5 61.2 56.8

70 162 166 151 148 153 154 158.5

IMT 13.46 28.07 24.47 20.3 25.84 25 25.82 22.62

Assesmen Gizi LILA (cm) 28 25 24.02 .25,0 27 24.03

Antro Ibu Hamil Perubahan BB IMT (sblm) Sesuai Tak Sesuai 28.07 v 24.47 v 20.3 v 25.84 v 25 v 25.82 v 22.62 v

Biokimia

HB 9,08, GDS 190 HB 12,22, GDS 77 HB 9,37, GDS 116 HB 11,99, GDS 91 HB 11,35, GDS 67 HB 9,10, GDS 111 HB 9,36, GDS 80

Klinis Penampilan Sulit mengunyah Sulit Menelan Gemuk Normal Kurus Ya Tidak Ya Tidak v v v v v v v v

Intervensi Gizi Edema Ya Tidak

Bentuk Makanan

Diagnosis Gizi Biasa NI- 5.3 NI52.3 NI- 53.5 NI- 52.1 NI-53.5 NI-53.5 NI-52.1 NI-52.1

Lunak Saring Cair v

v v v v v v v

Energi Protein (Kal) (g) 792 19.8 1506 56.47 1480 55.5 1018 38.17 1245 46.68 1287 48.26 1346 50.47 1249 46.83

Komposisi Gizi Lemak Vit. A KH (g) (g) (IU) 17.6 138.6 41.83 225.9 41.11 222 28.27 152.7 34.58 186.7 35.75 193.05 37.38 201.9 34.69 187.35

Vit C (mg)

Fe (mg)

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